Acute mercury poisoning (acrodynia) mimickingpheochromocytoma in an adolescent

Henningsson, Carina; Hoffmann, Stephanie; McGonigle, Lyle; Winter, J. S. D.

doi:10.1016/s0022-3476(06)80125-3

Cited by 36 publications

(23 citation statements)

References 4 publications

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“…A reduction in the breakdown of catecholamines produces the sympathetic symptoms such as hypertension and may result in a clinical picture mimicking pheochromocytoma [59][60][61].…”

Section: Clinical Presentationmentioning

confidence: 99%

Heavy metal poisoning: management of intoxication and antidotes

Rusyniak

Arroyo

Acciani

et al. 2010

Experientia Supplementum

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Abstract. Of the known elements, nearly 80% are either metals or metalloids. The highly reactive nature of most metals result in their forming complexes with other compounds such oxygen, sulfide and chloride. Although this reactivity is the primary means by which they are toxic, many metals, in trace amounts, are vital to normal physiological processes; examples include iron in oxygen transport, manganese and selenium in antioxidant defense and zinc in metabolism. With these essential metals toxicity occurs when concentrations are either too low or too high. For some metals there are no physiological concentrations that are beneficial; as such these metals only have the potential to cause toxicity. This chapter focuses on four of these: arsenic, mercury, lead and thallium.

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“…A reduction in the breakdown of catecholamines produces the sympathetic symptoms such as hypertension and may result in a clinical picture mimicking pheochromocytoma [59][60][61].…”

Section: Clinical Presentationmentioning

confidence: 99%

Heavy metal poisoning: management of intoxication and antidotes

Rusyniak

Arroyo

Acciani

et al. 2010

Experientia Supplementum

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“…Subacute onset of symptoms with a prolonged course is typical, but eventually, spontaneous and complete recovery occurs. Normal urine mercury levels do not rule out the diagnosis [4]; increased urinary excretion of catecholamines (suggesting pheochromocytoma or neuroblastoma) is a more consistent and diagnostically useful finding [6,7]. The causal link between exposure to mercury and the clinical phenotype, then called ''acrodynia'' (pain of the extremities), was noted by Feer back in 1923 [2,5,12], but even today, the pathogenesis is still not clear [2].…”

Section: Discussionmentioning

confidence: 99%

An 11-month-old boy with psychomotor regression and auto-aggressive behaviour

et al. 2003

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An 11-month-old Swiss boy was brought to his paediatrician. He had been in good health and had developed normally until then, but his parents mentioned that over the previous 2 weeks, the child no longer laughed or played, was becoming more and more restless, and slept only 1 to 2 h a night. He was no longer able to crawl and to stand up, and he had lost weight. Clinical examination revealed swollen hands and feet with skin desquamation, axial hypotonia and brisk reflexes. The child sweated profusely, refused to crawl or stand, showed stereotypic movements of the hands (kneading) and repeatedly bit objects or his own hands.Upon admission to the regional hospital, blood cell count, electrolytes, blood gas analysis, thyroid hormones and cerebrospinal fluid were normal. Liver and kidney parameters were normal, but plasma LDH and CK were increased to 724 U/l (normal <296 U/l) and to 270 U/l (normal <234 U/l), respectively. EEG, chest X-ray film, abdominal sonography, cranial CT scan and a muscle biopsy were all normal. Differential diagnosis at that point included a viral infection, neuroborreliosis, and coeliac disease, but laboratory investigations remained inconclusive.Two further weeks later, the symptoms persisted and the child was referred to a secondary centre. Clinical findings were unchanged; routine laboratory studies were again normal. EEG, brain MRI, and investigations for a metabolic disorder (ammonia, uric acid, amino acids, organic acids, acylcarnitines and mucopolysaccharides) were normal. The diagnosis remained obscure. The child was referred for further evaluation of severe psychomotor regression with autistic features of unknown aetiology.The child was admitted to our hospital at age 14 months. Length and weight, that had been at P50 at age 11 months, had declined to P3-10. The child appeared exhausted and irritable and sweated profusely. The hands and feet were swollen, erythematous and tender (Fig. 1). A fine maculo-papular exanthema was present on the trunk. There was muscular hypotrophy with peripheral oedema and axial hypotonia. Physical findings included tachycardia (160-180/min) and arterial hypertension (140/ 80 mmHg). The boy refused to stand, but would sit in a crouched position, had a sad and apathetic look, took little interest in his surroundings and would occasionally bite his hands and feet. A review of a videotape obtained during the first hospitalisation several weeks earlier showed that all features had been even more marked at that time.Abdominal sonography showed no signs of a tumour or renal disease; chest radiography and MIBG-scintigraphy showed no signs of a tumour. Echocardiography showed no signs of cardiomyopathy. An ophthalmological examination did not reveal corneal or lenticular abnormalities. An afebrile seizure occurred during hospitalisation: EEG and cerebral spinal fluid were again normal. Arterial hypertension and tachycardia had a good response to beta-blockers. Thyroid hormones were normal, but urinary excretion of epinephrine (epinephrine/ creatinine: 86 nmol/mm...

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“…is is important because urinary mercury levels do not necessarily correlate with the severity of clinical signs and symptoms of mercury intoxication [93,94].…”

Section: Tachycardiamentioning

confidence: 99%

The Influence of Arsenic, Lead, and Mercury on the Development of Cardiovascular Diseases

Jennrich¹

2013

ISRN Hypertension

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As a group, cardiovascular disease (CVD) is the leading cause of death worldwide. It killed twice as many people as infectious and parasitic disease and three times as many people as all forms of cancer. ere are other crucial risk factors next to the major risk factors identi�ed by the �ramingham Heart Study. In the last few years, detailed studies showed the correlation between environmental pollution and the development of CVD. e question, which environmental toxin is particularly harmful, is answered by CERCLA Priority List of Hazardous Substances with the following toxins: arsenic, lead, and mercury. e effect of these potential toxic metals on the development of cardiovascular diseases includes pathomechanisms as the accumulation of free radicals, damage of endothelial nitric oxide synthase, lipid peroxidation, and endocrine in�uences. is leads to the damage of vascular endothelium, atherosclerosis, high blood pressure, and an increased mortality from cardiovascular diseases. e cardiovascular effects of arsenic, lead, and mercury exposure and its impact on cardiovascular mortality need to be included in the diagnosis and the treatment of CVD.

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Acute mercury poisoning (acrodynia) mimickingpheochromocytoma in an adolescent

Cited by 36 publications

References 4 publications

Heavy metal poisoning: management of intoxication and antidotes

Heavy metal poisoning: management of intoxication and antidotes

An 11-month-old boy with psychomotor regression and auto-aggressive behaviour

The Influence of Arsenic, Lead, and Mercury on the Development of Cardiovascular Diseases

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